Hoffmeister Peter, Chaudhry G Muqtada, Orlov Michael V, Shukla Gunjan, Haffajee Charles I
Cardiac Pacing, Electrophysiology, and Arrhythmia Section, Caritas Saint Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135-2997, USA.
Pacing Clin Electrophysiol. 2006 Feb;29(2):117-23. doi: 10.1111/j.1540-8159.2006.00304.x.
Implantation of CS-LV pacing leads is usually accomplished through specialized sheaths with additional use of contrast venography and other steps. Direct implantation at a target pacing site could provide a simplified procedure with appropriate leads.
A progressive CS-LV lead implant protocol was used, with initial attempts made to place the lead directly using only fluoroscopy and lead stylet or wire manipulation. Coronary sinus (CS) sheaths were only used later if direct lead placement failed.
There were 105 attempted implants with 96% (101/105) success. Leads were implanted sheathlessly in 69% (70/101) cases. Pacing parameters and final lead position did not differ significantly between implants that did or did not require sheaths for implants. Three peri-procedural complications occurred in implants where sheaths were used. In 33% (33/101) of implants, the leads were placed without the use of sheaths or contrast venography in 20 minutes or less.
Direct placement of the CS-LV pacing lead without sheaths can be accomplished successfully in a majority of implants and in < or =20 minutes in a third, without inferior pacing parameters. This may provide for shorter or less technically difficult or expensive procedures with low risk.
冠状窦-左心室（CS-LV）起搏导线的植入通常通过专用鞘管完成，同时还需额外使用造影剂进行静脉造影及采取其他步骤。在目标起搏部位直接植入可使用合适的导线简化手术过程。
采用逐步的CS-LV导线植入方案，最初尝试仅使用荧光透视及导线管心针或导线操作直接放置导线。仅在直接放置导线失败后才使用冠状窦（CS）鞘管。
共进行了105次植入尝试，成功率为96%（101/105）。69%（70/101）的病例在无鞘管的情况下植入了导线。对于需要或不需要鞘管进行植入的情况，起搏参数和最终导线位置无显著差异。在使用鞘管的植入手术中发生了3例围手术期并发症。在33%（33/101）的植入手术中，导线在20分钟或更短时间内无需使用鞘管或造影剂静脉造影即可放置。
在大多数植入手术中，不使用鞘管直接放置CS-LV起搏导线能够成功完成，三分之一的手术可在20分钟或更短时间内完成，且起搏参数并无劣势。这可能会使手术时间缩短，技术难度降低或成本降低，风险也较低。
